Provider Demographics
NPI:1649161423
Name:MURRAY, JENNIFER (CASACT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:CASACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 W 15TH RD
Mailing Address - Street 2:
Mailing Address - City:BROAD CHANNEL
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1203
Mailing Address - Country:US
Mailing Address - Phone:917-678-5967
Mailing Address - Fax:917-678-5967
Practice Address - Street 1:17515 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5503
Practice Address - Country:US
Practice Address - Phone:917-678-5967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39993101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)